Selwyn J Ambazhachalil, PHARMD
Individual provider Active NPI Pharmacist · Linden, NJ
NPI 1962060210 · NPPES record last updated Jun 2, 2019
Key facts
- NPI
- 1962060210
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 28RI03896000 (NJ)
- Practice address
- 651 N Stiles St
Linden, NJ 07036-5759 - Phone
- (908) 718-5459
- NPI assigned
- Jun 2, 2019
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28RI03896000 | NJ | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 28RI03896000 | NJ | Yes |
Addresses
Primary practice location
651 N Stiles St
Linden, NJ 07036-5759
Mailing address
49 Fellswood Dr
Livingston, NJ 07039-2235
Other providers in Linden, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 2, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.